New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/4/2024 4:24:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Dr. Mohamad Hajj Ali
Notes:: Airlite + AR Lenses 1.61

	SPH	CYL	AX	ADD
OD	-2.75	-2.25	180
OS	-1.75	-2.75	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS